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General NPI Number Information
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NPI Number | 1134105679
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Entity Type | Organization
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Legal Business Name | JANSEN ORTHOPAEDIC CLINIC, LLC
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Dates
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Enumeration Date | 12/16/2005
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Last Update Date | 01/16/2009
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Provider Practice Location Address
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Address Line | 2124 N BIOMET DR
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City | WARSAW
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State | IN
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Zip | 46582-7858
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Country | US
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Telephone | 574-267-2663
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Fax |
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Provider Business Mailing Address
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Address Line | 2124 N BIOMET DR
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City | WARSAW
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State | IN
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Zip | 46582-7858
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Country | US
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Telephone | 574-267-2663
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Fax |
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Authorized Official
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Title or Position | MD/OWNER
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Name | DR. LEO DEAN JANSEN
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Credential | M.D.
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Telephone | 574-267-2663
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number |
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License Number State |
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